Indonesian government mum as AP reports H5N1 case

Jun 13, 2008 (CIDRAP News) – An Indonesian woman died of H5N1 avian influenza 10 days ago, but her case has not yet been publicly confirmed by the government, which is continuing to withhold information about avian flu cases, the Associated Press (AP) reported today.

The news came on the heels of the word from a World Health Organization (WHO) official that Indonesia has promised to keep the agency informed of human cases and deaths, as it is obligated to do under the International Health Regulations (IHR). The WHO official's comments appeared to contradict statements last week from Indonesia's health minister.

On Jun 5, Health Minister Siti Fadilah Supari said the government would no longer report human H5N1 cases and deaths promptly to the WHO. Different news accounts said she planned to report cases after they were reported in the news media or only at 6-month intervals. Supari said she wanted to focus attention on the country's successes in fighting avian flu.

Today's AP story says that a 34-year-old woman named Susi Lisnawati died of avian flu Jun 3. Speaking anonymously, a senior health ministry official and four other health workers confirmed the case to the AP. But the government had not yet notified Lisnawati's husband, Ali Usman, that she had the virus, according to the story, which came from Bitung, a city near the northeastern tip of Sulawesi island.

The case has not been reported in the local news media, and it took the AP a week to track down and confirm it, the report said.

The case apparently raises Indonesia's H5N1 death toll to 110, out of a total of 135 cases. The WHO's tally for Indonesia stands at 133 cases with 108 deaths; the agency has not yet included Lisnawati and a 15-year-old girl whose case was announced by Supari just last week, though she had died May 14.

Dr. David Heymann, the WHO's assistant director general for health security and environment, said yesterday that Indonesia had assured the agency it would continue reporting avian flu cases, according to a Canadian Press (CP) report published yesterday.

"We've received official notice at our WHO office in Jakarta that the minister will continue—as she has been—notifying WHO on confirmed infections under the International Health Regulations," Heymann told CP.

"She's been clear . . . that she has no intention of not conforming to the International Health Regulations," he said. "She knows what they are. She's been told what those regulations require."

Today's AP story carried similar comments from Heymann. But according to the AP account, Heymann said it doesn't matter if it takes several weeks for the government to report cases, "as long as the virus is known about and handled properly." He also said it did not appear that Indonesia was flouting the IHR.

Under the IHR—agreed to by all WHO member countries—governments are required to quickly report cases of diseases labeled as global health threats. Novel influenza strains are among the diseases that countries are specifically obligated to report.

Indonesia has been at odds with the WHO since early 2007, when Supari announced the government would no longer send H5N1 virus samples to the agency. The country wants guarantees that it will receive a supply of any vaccine derived from the isolates it supplies. The WHO has relied for decades on free sharing of flu viruses in its effort to identify new strains, develop vaccines, and monitor drug resistance.